Category Archives:

It is a beautiful September morning when the tones go off for a 86 year old female, “altered mental status”. “Guess breakfast will have to wait”, as you and your partner head towards the residence. As you enter the one level home, you are directed to a back bedroom where you find your patient […]

You respond to an office workplace for a 43-year-old female with a chief complaint of chest discomfort. On arrival you are greeted by the patient who is pleasant and well-appearing. Her skin is warm, pink, and dry and pulse strong at the radials. Respiratory effort is normal with clear lung sounds bilaterally and she does […]

This is the conclusion to our latest case, 59 Year Old Male: Unwell. I suggest starting there and reviewing the scenario before diving into this discussion. I was glad to see our latest case generated quite a bit of debate. This is a difficult tracing coupled with an equally difficult clinical scenario, so it wasn’t […]

**UPDATE** The conclusion to this case is now posted here. It’s the middle of the afternoon when you are dispatched to the residence of a 59 year old male with a chief complaint of general illness. When you arrive on scene you encounter a middle-aged man in obvious distress, lying on a couch. He is […]

Snapshot cases are tracings where we do not have good patient follow-upâ€”or sometimes even clinical informationâ€”but still feel there are points worth discussing. This is a patient who required emergent cardioversion for unstable rapid atrial fibrillation. What happened? Tracing shared by Rob McDonald, and emergency department nurse in Queensland, Australia.

This is the second half of a two-part case presentation examining transcutaneous pacing. If you didn’t see yesterday’s post I highly suggest checking out Part 1 before continuing, but if you hate learning I suppose you can start here. Yesterday we examined a series of tracings that depicted transcutaneous pacing (TCP) in all its stages: […]

Anyone trained in transcutaneous pacing (TCP) needs to be able to identify the rhythm below instantly. It shows a patient being transcutaneously paced at 80 bpm and 125 mA on a LifePak 12 [the strip is labelled 130 mA but that refers to a point just past the end of the paper, I promise]. Well, […]

This is the conclusion to the Snapshot Case from a couple of days ago. If you haven’t already done so, I suggest reviewing the very brief initial case description. Here again is the EKG from Tuesday’s case. This tracing is nearly pathognomonic for true occlusion of the left main coronary artery (LMCA), resulting in a […]

Snapshot cases are EKG’s where we do not have good patient follow-up or sometimes even clinical information but still feel there are worthwhile learning points to convey. This is an old case we’ve actually featured on the blog before, but today we’re going to do so with a different focus. This ECG is from an […]

Last week we presented the ECG of a patient experiencing progressively worsening shortness-of-breath over the course of a day and some marked ECG abnormalities. If you haven’t done so already, it would probably be a good idea to check out the original post first. Strap in, this is going to be a thorough discussion. Here […]

Ken Grauer58 Year Old Male, Workout Worry@ Eli — I don’t see AFlutter. That is, I see no indication of regular atrial activity at a rate consistent with AFlutter. Instead, the rhythm is irregularly irregular without P waves = AFib at a controlled ventricular response. In my opinion, one doesn’t need Sgarbossa criteria here to activate the cath lab. So, yes the…
2018-09-13 02:09:24

Vince DiGiulioIs epinephrine harmful in cardiogenic shock?Sorry about that; I copied the quote from the article and my browser automatically changed the "μ" to an "m". Thanks for noticing, and thanks for pointing it out in the most passive-aggressive manner possible.
2018-09-12 16:45:26

Ken Grauer, MDElectrocardiographically Silent High Lateral STEMI EquivalentHi Tom. This is a great case — so NICE that you posted it for others to learned from. But as I commented several times when you sent this case around to our group — the T waves in V2,V3 are disproportionately peaked and transition occurs early (between V1-to-V2) — so the chest leads are NOT…
2018-08-14 08:38:03

Eli58 Year Old Male, Workout WorryAnybody else see the possibility of a LBBB or A-Flutter? I'm not sure if this will make any difference with the treatments but im just trying to interpret it first because if there is a LBBB then it does not meat Sgarbossa criteria and if it is A-Flutter that could explain the hyper acute T's…
2018-07-20 21:29:21